Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Rd, Wuhan, Hubei 430022, China.
Department of Translational Medicine Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China.
Biochim Biophys Acta Mol Basis Dis. 2022 Jan 1;1868(1):166289. doi: 10.1016/j.bbadis.2021.166289. Epub 2021 Oct 14.
To explore the recovery of renal function in severely ill coronavirus disease (COVID-19) survivors and determine the plasma metabolomic profile of patients with different renal outcomes 3 months after discharge, we included 89 severe COVID-19 survivors who had been discharged from Wuhan Union Hospital for 3 months. All patients had no underlying kidney disease before admission. At patient recruitment, renal function assessment, laboratory examination, chest computed tomography (CT) were performed. Liquid chromatography-mass spectrometry was used to detect metabolites in the plasma. We analyzed the longitudinally change in the estimated glomerular filtration rate (eGFR) based on serum creatinine and cystatin-c levels using the CKD-EPI equation and explored the metabolomic differences in patients with different eGFR change patterns from hospitalization to 3 months after discharge. Lung CT showed good recovery; however, the median eGFR significantly decreased at the 3-month follow-up. Among the 89 severely ill COVID-19 patients, 69 (77.5%) showed abnormal eGFR (<90 mL/min per 1.73 m) at 3 months after discharge. Age (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.08-1.47, p = 0.003), body mass index (OR = 1.97, 95% CI = 1.20-3.22, p = 0.007), and cystatin-c level (OR = 1.22, 95% CI = 1.07-1.39, p = 0.003) at discharge were independent risk factors for post-discharge abnormal eGFR. Plasma metabolomics at the 3-months follow-up revealed that β-pseudouridine, uridine, and 2-(dimethylamino) guanosine levels gradually increased with an abnormal degree of eGFR. Moreover, the kynurenine pathway in tryptophan metabolism, vitamin B6 metabolism, cysteine and methionine metabolism, and arginine biosynthesis were also perturbed in survivors with abnormal eGFR.
为了探讨重症冠状病毒病（COVID-19）幸存者的肾功能恢复情况，并确定出院后 3 个月不同肾功能结局患者的血浆代谢组学特征，我们纳入了 89 名从武汉协和医院出院 3 个月的重症 COVID-19 幸存者。所有患者入院前均无基础肾脏疾病。在患者招募时，进行了肾功能评估、实验室检查、胸部计算机断层扫描（CT）。采用液相色谱-质谱联用技术检测血浆中的代谢物。我们使用 CKD-EPI 方程分析了基于血清肌酐和胱抑素-c 水平的估算肾小球滤过率（eGFR）的纵向变化，并探讨了从住院到出院后 3 个月不同 eGFR 变化模式患者的代谢组学差异。肺 CT 显示恢复良好；然而，中位 eGFR 在 3 个月随访时显著下降。在 89 例重症 COVID-19 患者中，有 69 例（77.5%）在出院后 3 个月时出现异常 eGFR（<90 mL/min/1.73 m）。年龄（比值比[OR] = 1.26，95%置信区间[CI] = 1.08-1.47，p = 0.003）、体重指数（OR = 1.97，95%CI = 1.20-3.22，p = 0.007）和胱抑素-c 水平（OR = 1.22，95%CI = 1.07-1.39，p = 0.003）是出院后异常 eGFR 的独立危险因素。在 3 个月随访时的血浆代谢组学分析显示，β-假尿嘧啶、尿嘧啶和 2-（二甲基氨基）鸟苷水平随 eGFR 异常程度逐渐升高。此外，色氨酸代谢中的犬尿氨酸途径、维生素 B6 代谢、半胱氨酸和蛋氨酸代谢以及精氨酸生物合成在异常 eGFR 幸存者中也受到干扰。
